The purpose of this session for attendees is:
1. To consider multiple mechanisms and their interactions in persistent pain
2. To critically understand the difference between mechanistic descriptors and neurophysiological mechanisms (e.g., nociplastic pain vs sensitization)
3. To critically understand the background rationale, causation and prognosis regarding the association between different mechanisms and how this influences treatment options
Description
At the beginning of the session, Morten Hoegh will present the three mechanistic pain descriptors (nociceptive, neuropathic and nociplastic) and continue with a presentation of the neurophysiological mechanisms related to the central sensitization-phenomena (wind-up, classical central sensitization and long-term potentiation). Afterwards, he will discuss the overlap between mechanisms and descriptors.
Sean Gibbons will present persistent pain within the disease pathogenesis framework. He will discuss low grade systemic inflammation mechanisms, his research on how to identify immune dysregulation and strategies for subgrouping. He will also discuss the importance of addressing functional mechanisms in the clinical reasoning of intervention strategies. Following this he will highlight tissue mechanisms and how they may be influenced by immune dysregulation.
Susanne Becker will present results on factors that can induce endogenous pain modulation in humans, focusing specifically on the perception of reward, and related motivation and learning. In particular, she will present recent evidence highlighting the importance of these factors in the modulation of pain, including persistent pain. Recent research convincingly shows the relevance of reward processing as a pathogenetic factor in chronic pain. This presentation will discuss this evidence and link it to potential novel intervention strategies in patients with chronic pain.
Ashley Smith will present an overview of the evidence investigating both conservative and medical options to modulate the clinical features of central sensitization in a variety of chronic pain disorders. In particular, he will summarize his research investigating the role of nociception and its influence on various forms of endogenous analgesia. This presentation will also cover testing paradigms of central sensitization, including temporal summation, conditioned pain modulation and exercise induced hypoalgesia. Through a clinical reasoning framework, Ashley will provide a rationale for appropriately directing patient care, based on a patient’s pain modulation profile.
In the following discussion, the presenters together answer questions from the audience in a panel discussion format.
Implications/conclusions
Persistent pain involves multiple mechanisms. By understanding the mechanisms contributing to the persistent pain, physiotherapist could optimise treatment (e.g., lifestyle, manual therapy, therapeutic exercise, behavioral, education) and prognosis in various pain conditions. Effective recognition of the factors associated with this clinical presentation and the options available to modulate such allows physiotherapists to assist patients’ recovery trajectories.